Prognostic significance of tumor spread through air spaces in patients with stage IA part-solid lung adenocarcinoma after sublobar resection

Chae, Mincheol; Jeon, Jae Hyun; Chung, Jin Haeng; Lee, So Young; Hwang, Wan Jin; Jung, Woohyun; Hwang, Yoohwa; Cho, Sukki; Kim, Kwhanmien; Jheon, Sanghoon

doi:10.1016/j.lungcan.2020.12.001

Cited by 28 publications

(33 citation statements)

References 25 publications

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“…Previous studies demonstrated that presence of STAS was an unfavorable factor for recurrence and long-term survival in patients with lung cancers [7,8,[14][15][16][17]. In 2018, Hu and colleagues even suggested that STAS might be considered as a staging profile in future staging system [18].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported that STAS was a risk factor for recurrence in lung adenocarcinoma after sublobar resection [6,7,20,24]. In 2019, Eguchiand and colleagues showed that patients with STAS who underwent sublobar resection had a higher risk of recurrence than lobectomy by using a propensity score-matched analysis [25].…”

Section: Discussionmentioning

confidence: 99%

“…Tumor spread through air spaces (STAS) is defined as spread of lung cancer tumor cells into air spaces in the lung parenchyma adjacent to the main tumor and it is listed as an additional invasive pattern of lung adenocarcinoma in the World Health Organization guidelines [4]. Recently, several studies have demonstrated that STAS was an independent prognostic factor for post-operative recurrence of lung adenocarcinoma [5][6][7][8][9]. In 2018, Toyokawa and colleagues reported that STAS predicted a poor recurrence-free survival (RFS) in completely resected lung adenocarcinomas with lymph node metastasis [10].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic implication of tumor spread through air spaces in patients with pathologic N0 lung adenocarcinoma

Chen

Yang

et al. 2022

Lung Cancer

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Tumor spread through air spaces (STAS) has been identified as an invasive pattern in lung adenocarcinoma (ADC), but the prognostic implication of STAS has not been well studied in patients with pathologic N0 lung ADC. The purpose of this study was to evaluate the prognostic implication of STAS in pathologic N0 lung ADC patients after radical surgery. Materials and methods: Between January 2017 and December 2018, 796 patients with completely resected pathologic N0 lung ADC were reviewed. Pearson's chi-square test or Fisher exact test was used for comparing the relationship between STAS and clinicopathological features. The log-rank test and multivariate Cox regression models were used to explore prognostic factors. Results: Among the 796 patients, STAS was positive in 201 patients (25.3%). The presence of STAS was significantly associated with patients with solid nodules (P < 0.001), micropapillary pattern-predominant adenocarcinoma/solid pattern-predominant adenocarcinoma (P < 0.001), larger tumor size (P < 0.001), visceral pleural invasion (P < 0.001) and lymphovascular invasion (P < 0.001). Multivariable analysis showed that STAS was an independent prognostic factor for recurrence-free survival (RFS) in pathologic N0 lung ADC patients (P = 0.014). For patients with acinar pattern-predominant adenocarcinoma (APA) / papillary pattern-predominant adenocarcinoma (PPA) / invasive mucinous adenocarcinoma (IMA) and patients who underwent lobectomy, STAS was an independent prognostic factor for RFS (P = 0.015, P = 0.011; respectively) and overall survival (OS) (P = 0.038, P = 0.020; respectively). Conclusion: In this study, STAS was an independent prognostic factor for RFS in pathologic N0 lung adenocarcinomas, and it was also an independent prognostic factor for RFS and OS in patients with APA/PPA/IMA and those who received lobectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prognostic implication of tumor spread through air spaces in patients with pathologic N0 lung adenocarcinoma

Chen

Yang

et al. 2022

Lung Cancer

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“…STAS is widely associated with worse long-term outcomes (169,176)-but also associated with multiple negative prognostic factors, e.g., aggressive adenocarcinoma subtypes (e.g., solid, micropapillary) (166,167,174,(177)(178)(179)(180)(181), higher stage (174,175,180,182,183), larger tumors (169,174,175,(180)(181)(182)(183), and a greater solid component on imaging (172,175,181). No consistent correlation of STAS with genetic characteristics has emerged (169).…”

Section: Impact Of Stasmentioning

confidence: 99%

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 2: systematic review of evidence regarding resection extent in generally healthy patients

Detterbeck¹,

Mase²,

Li³

et al. 2022

J Thorac Dis

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Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand).A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making.Methods: A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results:In healthy patients there is no short-term benefit to sublobar resection vs. lobectomy in randomized and non-randomized comparisons. A detriment in long-term outcomes is demonstrated by adjusted non-randomized comparisons, more marked for wedge than segmentectomy. Quality-of-life data is confounded by the use of video-assisted approaches; evidence suggests the approach has more impact than the resection extent. Differences in pulmonary function tests by resection extent are not clinically meaningful in healthy patients, especially for multi-segmentectomy vs. lobectomy. The margin distance is associated with the risk of recurrence.

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“…In general, the absolute margin should be at least 2 cm, while in some cases where the tumor is very small, it should be equivalent to the size of the tumor [13]. Recent studies have shown that cancer cells can spread through air spaces (STAS), which means that sublobar resection may be risky even in GGN lung adenocarcinoma [14]. In other words, tumor cells can spread beyond a certain distance from in situ lesions, so lobar resection is recommended.…”

Section: Jcs Jcog0802mentioning

confidence: 99%

Surgical Extent for Ground Glass Nodules

Cho

2021

J Chest Surg

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As diagnoses of small ground glass nodule (GGN)-type lung adenocarcinoma are increasing due to the increasing frequency of computed tomography (CT) screening, surgical treatment for GGN-type lung adenocarcinoma has rapidly become more common. However, the appropriate surgical extent for these lesions remains unclear; therefore, several retrospective studies have been published and prospectively randomized controlled trials are being undertaken. This article takes a closer look at each clinical study. Convincing evidence must be published on 2 issues for sublobar resection to be accepted as a standard surgical option for GGN lung adenocarcinoma. In the absence of such evidence, it is better to perform lobar resection as long as the patient has sufficient lung function. The first issue is the definition of a sufficient resection margin, and the second is whether lymph node metastasis is conclusively ruled out before surgery. An additional issue is the need for an accurate calculation of the total size and solid size on CT. Given the results of clinical studies so far, wedge resection or segmentectomy shows a good prognosis for GGNs with a total size of 2 cm or less. Therefore, sublobar resection will play a key role even in patients who can tolerate lobectomy.

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Prognostic significance of tumor spread through air spaces in patients with stage IA part-solid lung adenocarcinoma after sublobar resection

Cited by 28 publications

References 25 publications

Prognostic implication of tumor spread through air spaces in patients with pathologic N0 lung adenocarcinoma

Prognostic implication of tumor spread through air spaces in patients with pathologic N0 lung adenocarcinoma

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 2: systematic review of evidence regarding resection extent in generally healthy patients

Surgical Extent for Ground Glass Nodules

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